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NBDE II Board Busters > Periodontics > Flashcards

Periodontics Flashcards

1
Q

periodontium is composed of? (4)

A
  • gingiva
  • PDL
  • cementum
  • alveolar and supporting bone
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2
Q

attachment apparatus (3)

A
  • alveolar bone proper
  • PDL fibers
  • cementum
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3
Q

gingival apparatus (2)

A
  • gingival fibers

- epithelial attachment

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4
Q

gingival ligament (3)

A

fibers:

  • dentogingival
  • alveologingival
  • circular
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5
Q

Alveolar process

A
  1. Alveolar bone proper - inner layer of compact lamellar bone, surrounds where PDL fibers attach, vessels and nerves pass btw PDL and bone marrow
  2. Supporting alveolar bone - cortical plate (compact lamellar), spongy (cancellous, NOT in anterior mouth)
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6
Q

small collagen fibers in the PDL that run in all directions and are assoc. with larger principal collagen fibers is the

A

indifferent fiber plexus

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7
Q

free gingiva components (4)

A
  1. gingival margin
  2. free gingival groove - sep. free gingiva from attached, only in 33% ppl
  3. gingival sulcus - btw marginal gingiva and tooth, bound by sulcular epithelium laterally and JE apically
  4. interdental (interprox) gingiva
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8
Q

gingival fibers have type __ collagen

found in what part of gingiva?

A

Type I

free gingiva, continuous with PDL

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9
Q

types of gingival fibers (5)

A
  1. alveologingival - alveolar process to lamina propria in free gingiva
  2. circular - resists ROTATION, inserts into cementum and lamina propria of free gingiva and alveolar crest
  3. dentogingival - from cementum apical to epithelial attachment (JE); into lamina propria of gingiva
  4. dentoperiosteal - cervical cementum to periosteum of cortical plates
  5. transseptal - connect adj. teeth, classified within PDL principal fibers, embedded in cementum, not on facial, not attached to bone, maintain integrity of dental arches
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10
Q

ATTACHED GINGIVA

A
  • attached to underlying periosteum of alveolar bone and to cementum of CT fibers and epithelial attachment
  • btw free gingiva and alveolar mucosa
  • contains keratinized epithelium and lamina propria of dense fiber bundles with few elastic bundles

-firmly bound, color depends on keratinization, thickness, amt melanin, blood

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11
Q

where is the narrowest band of attached gingiva

A

facial surfaces of md canine and 1st PM
lingual surfaces adj. to md incisors and canines
MB root of mx 1st molar
md 3rd molars

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12
Q

with of facial attached gingiva ranges from __ to __ mm

where is it widest? narrowest?

A

1-9 mm

facial of mx lateral; narrowest on facial of md canine and 1st PM

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13
Q

what is the functionally adequate zoe of gingiva

A

keratinized, firmly bound to tooth and underlying bone, 2mm_ wide, resistant to probing and gaping when lip is distended

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14
Q

boundaries of attached gingiva

A

MGJ to gingival groove (base of sulcus)

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15
Q

MGJ separates __

free gingival groove separates __

free gingiva extends from __ to __

A

attached gingiva from alveolar mucosa

free gingiva from attached gingiva

free gingival groove to gingival margin

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16
Q

what is stippling?

A

irregular surface of attached gingiva
-at intersection of epithelial ridges -> cause depression and interspersing of CT papilla

-in absence of stippling, edema of CT, inflammatory degradation of gingival collagen, normal variation can result in areas of attached gingiva

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17
Q

what type of epithelium is all oral mucosa?

A

stratified squamous REGARDLESS if it’s keratinized or not

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18
Q

non-keratinized oral mucosa found in

A
  • buccal and alveolar mucosa
  • tongue’s inferior (ventral) surface
  • soft palate
  • FOM
  • special and lining mucosa
  • col
  • crevicular epithelium
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19
Q

alveolar mucosa

A
  • fxns as lining
  • apical to attached gingiva on facial and lingual side
  • NON-KERATINIZED, has elastic fibers
  • permits movement but can’t stand frictional stress
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20
Q

keratinized oral mucosa found in

A
  • hard palate

- attached gingiva

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21
Q

functional oral mucosa includes (3)

A
  1. masticatory - free and attached gingiva, KERATINIZED
  2. lining (reflective) - whole oral cavity except gingiva, anterior palate, dorsum of tongue, movable, NON-keratinized
  3. specialized - NON-keratinized, tongue dorsum, taste buds
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22
Q

PDL

A
  • highly vascular
  • cellular CT surrounds roots of teeth
  • most fibers are collagen; ground substance consists of proteins and polysacchs
  • hour-glass shaped
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23
Q

most abundant cell type in PDL

A

fibroblasts

-ovoid/elongated, exhibit pseudo-podial-like processes

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24
Q

epithelial rests of malassez

A

remnants of Hertwig’s root sheath, found as group epithelial cells in the PDL

-some degenerate; others become cementicles

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25
Q

PDL functions (5)

A
  1. physical
  2. formative
  3. resorptive
  4. nutritive
  5. sensory
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26
Q

4 features that directly affect PDL health and its hard tissue anchorage to resist occlusal forces

A
  1. anterior teeth have slight or no contact in MI
  2. occlusal table is <60% overall F-L width of tooth
  3. occlusal table at right angles to long axis
  4. md molar crowns are inclined 15-20% to lingual
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27
Q

sensory fxns of PDL carried by what nerve?

2 types of nerve endings

A

CN V

  1. free, unmyelinated -> PAIN
  2. encapsulated, myelinated -> PRESSURE
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28
Q

PDL thickness avg?

PDL thickness depends on (4)

A

0.25 mm

  1. age
  2. stage of eruption
  3. fxn of tooth
  4. trauma hx
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29
Q

PDL has this type collagen fibers

what type of elastin fibers?

A

Type I collagen

2 immature elastin forms (oxytalan, eluanin) NO mature

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30
Q

__ fibers run parallel to root surface; bend to attach cementum in cervical third

A

oxytalan fibers

-regulate vascular flow

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31
Q

PDL is derived from the

A

dental sac

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32
Q

PDL CT fibers, 2 groups

A
  1. gingival - support marginal gingiva and papilla
    incl. circular, dentogingival, dentoperiosteal, alveologingival, transseptal
  2. principal - connect root cementum to bone
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33
Q

Sharpey’s fibers

A

terminal part of PDL principal collagen fibers, embedded into cementum and bone
-diameter greater on bone side > cementum

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34
Q

principal fibers

A
  1. horizontal
  2. alveolar crest
  3. oblique - resist along axis, mostly in root’s middle third
  4. apical - provides initial resistance in occlusal direction
  5. interradicular - only multirooted teeth
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35
Q

gingival crevicular fluid

A

desquamating epithelium and neutrophils

  • incr. flow is first sign of inflammation
  • after inflammation -> high level of serum proteins and leukocytes
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36
Q

nutrients for gingival epithelium cells are from

A

capillaries in subjacent CT

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37
Q

dentojunctional epithelium

A

faces tooth, non-keratinized stratified squamous epithelium

composed of

  1. sulcular epithelium
  2. junctional epithelium
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38
Q

sulcular epithelium

A

lines sulcus, connects directly with JE

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39
Q

junctional epithelium

A

stratifed squamous epithelium attached by HEMIDESMOSOMES

10-20 cells thick at beginning -> few cell layers

2 layers - basal and suprabasal

in IDEAL gingiva, JE located entirely on enamel above CEJ

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40
Q

epithelial attachment is part of ___

components? (3)

A

JE, provides attachment

  1. lamina lucida
  2. lamina densa
  3. hemidesmosomes
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41
Q

epithelial attachment does not contain ___ which free gingiva does

A

RETE PEGS

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42
Q

greatest contour of cervical lines and gingival attachments occur on the __ surface of the __ teeth

A

mesial surface of anterior teeth

-mesial of central greatest

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43
Q

in absence of perio disease, crest of interdental alveolar septa is determined by

A

CEJ on adjacent teeth

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44
Q

width of interdental alveolar bone is determined by

A

tooth form present

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45
Q

autogenous free gingival graft

A

gingiva placed on viable C.T. bed where initially buccal or labial mucosa were present

  • donor site is an edentulous region or palate
  • maturation not complete til 10-16 wks
  • most shrinkage in first 6 wks
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46
Q

free gingival graft

A

-remove attached gingiva from another part of mouth and suture it to recipient site

GOAL: more attached gingiva, root coverage
(hard to get root coverage because avascular graft/no blood)

INDICATIONS:

  • prevent recession, widen attached gingiva
  • cover dehiscences, fenestration
  • with frenectomy
  • correct localized NARROW recessions/clefts but not wide -> laterally repositioned flap (pedicle graft) better
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47
Q

FGG gets its nutrients from

A

viable C.T. bed

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48
Q

main reason FGG fails is

A
  1. disruption of vascular supply

2. infxn

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49
Q

FGG rarely used for what surfaces

A

facial or lingual of md 3rd molars

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50
Q

FGG healing

A
  • top layers last revascularized
  • necrotic slough
  • re-epithelialization by proliferation of epithelial cells from adj. tissue and surviving basal cells of graft tissue
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51
Q

free mucosal allograft is diff. from FGG in that

A

the transplant is C.T. without an epithelial covering

  • epithelial differentiation is from underlying CT so grafts from keratinized areas will form keratinized tissue when transplanted
  • often on CANINES where little keratinized gingiva exists to create some gingiva-like tissue
  • healing is same as FGG
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52
Q

root amputation

A

usually mx 1st and 2nd molars

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53
Q

hemisection

A

usually md molar region

-50% of tooth is ext if one specific root has excessive loss in osseous support

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54
Q

distal wedge (proximal wedge) flap

A

simplest distal flap for retromolar reduction

  • often after 3rd molar ext (bone fill poor)
  • region occupied by glandular and adipose tissue, covered by unattached, non-keratinized mucosa

-wedge base is periosteum overlying bone; apex is coronal gingival surface

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55
Q

where are distal wedge flaps

A

mx tuberosity
md retromolar triangle
distal to last tooth
mesial to tooth by edentulous area

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56
Q

osseous recontouring surgery goal

A

eliminate perio pockets

tx alternatives: periodic root planing, bone graft reattachment-fill procedures, hemisection, root amputation

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57
Q

most critical factor to determine if tooth should be ext or have surgery is

A

amt of attachment loss (apical migration of epithelium attachment)

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58
Q

primary objective of surgical flaps in treating perio disease is

A

access root surfaces for debridement

-reduce/eliminate pockets, regrow bone, maintain biologic width, establish soft tissue contour

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59
Q

without visualization by flap, hard to root plane beyond __ mm of PD or into furcations of lesser depth

A

5 mm

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60
Q

if pt fails to demo good OH during initial therapy (SRP), ___ is contraindicated

A

surgery

  • incidence of disease recurrence is greater if OH is poor
  • –> stress OH, maintain with SRP
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61
Q

periodontal flap

design

A

segment of marginal perio tissue that’s sx separated coronally and attached apically by pedicle of supporting vascular CT

  • flap base must be uniformly thin 2 mm; corners ROUNDED
  • base is wider than free margin (for blood)
  • don’t make incisions over defects in bone
  • don’t traverse bony eminence (canine) -> scar!
  • don’t incise in infected tissue (can spread)
  • ROUND corners (or else delayed healing)
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62
Q

deep perio pockets are often treated by

A

flap surgery

-reduced PD by formation of long junctional epithelium

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63
Q

best indicator of success of perio flap is

A

postop maintenance and plaque control by pt

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64
Q

most commonly used flaps

A
  1. full thickness mucoperiosteal
    - surface mucosa (epithelium, basement memb., CT., lamina propria), periosteum
    - used when attached gingiva is < 2 mm
    - APICALLY and CORONALLY positioned flaps
  2. partial thickness
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65
Q

Modified Widman Flap (MWF) is what kind of flap?

used in?

what teeth?

A

full thickness mucoperiosteal

  • used on open flap debridement; regenerative perio procedures
  • single rooted teeth, flap surfaces of molars
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66
Q

Modified Widman Flap objectives?

indications?

A
  • access, reduce pocket depth, preserve attached gingiva, heal by primary closure
  • pocket bases coronal to MGJ, little or no thickened marginal bone, shallow to moderate pockets can be reduced, esthetics (anteriors)
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67
Q

Repositioned flaps incl. replaced flaps, MWF, excisional new attachment procedures

All heal by ___

A

repair - long junctional epithelium and CT adhesion or attachment, for POCKET REDUCTION

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68
Q

Partial thickness perio flap includes only __ epithelium and layer of __

used when attached gingiva is ___ mm

A

MUCOSA epithelium and layer of underlying C.T.

mucosa separated from periosteum by SHARP DISSECTION

to prepare sites for free gingival grafts, fix dehiscences/fenestrations

attached gingiva is THICK > 2 mm

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69
Q

___ and __ flaps can be displaced, but ___ cannot!

A

full thickness and partial thickness CAN

palatal CANNOT because it has NO unattached gingiva

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70
Q

3 types of POSITIONED FLAPS

A
  1. Pedicle (laterally positioned) flap
    - FULL thickness, fixes morphology/position/amt of attached gingiva
    - indicated for NARROW gingival recession next to wide band of attached gingiva, corrects recession, WIDENS zone of gingiva
    - attached at base by pedicle of lining mucosa and intact blood supply
  2. Apically Positioned Flap
    - FULL thickness, predictable, gets rid of deep pockets, retains attached gingiva, exposes alveolar margin (stimulates gingiva growth)
    - indicated for moderate/deep pockets, furcations and CROWN LENGTHENING
    - contraindicated for pts at risk for root caries
  3. Coronally Positioned Flap
    - FULL thickness
    - to restore gingival height and attached gingiva over recession
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71
Q

double papilla flap is a variation of the __ flap

A

laterally positioned flap, the papilla on either side are placed over exposed root

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72
Q

no necrotic slough of positioned flaps because they ____

A

carry their vascular supply with them

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73
Q

Internal bevel incision objectives (3)

A
  1. remove pocket lining
  2. conserve uninvolved gingiva (if apically positioned, becomes attached gingiva)
  3. produce a sharp, thin flap margin to adapt to the bone-tooth jxn
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74
Q

gingivoplasty is to

A

RESHAPE gingiva and papilla, NOT to get rid of pockets

ex. correct ANUG

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75
Q

gingivectomy is to ___

indications? contraindications?

A

ELIMINATE pocket depth by resecting tissue coronal to pocket base

  • indicated for: pseudopockets, hereditary gingival enlargement, suprabony pockets, hyperplasia (Dilantin)
  • contraindicated: infrabony pockets, lack of attached tissue, bad esthetics, no access, broad wounds
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76
Q

don’t do a gingivectomy if ___

A

if base of pocket is located at the MGJ or apical to alveolar crest

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77
Q

factors to consider when electing to perform a gingivectomy rather than periodontal flap

A
  • pocket depth
  • access to bone
  • amt of attached gingiva
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78
Q

___ is the removal of osseous defects or infrabony pockets by eliminating bony pocket walls

A

ostectomy

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79
Q

major contraindication for removing crestal bone is if ___

A

removal weakens the adjacent tooth’s bony support

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80
Q

suprabony pockets, bone loss is horizontal/vertical?

A

horizontal, INTRAosseous

pocket base (epithelial attachment) is coronal to crest of alveolar bone

can be a GINGIVAL (relative/pseudopocket) - coronal movement of tissue, NOT apical, NO attachment loss

or PERIODONTAL (true) pocket - APICAL migration of epithelial attachment

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81
Q

horizontal/vertical? bone loss does NOT parallel CEJ, and is found in isolated teeth

A

VERTICAL

INFRAbony - classified by # bony walls left, pocket base is APICAL to crest of alveolar bone

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82
Q

Infrabony Wall Classifications

A

1-wall “hemiseptum” only proximal wall left, a “ramp” if only a facial or lingual wall is left

2-wall ex. interdental crater

3-wall an INTRAbony pocket, best for bone graft and regeneration

4-wall circumferential/moat, best for bone graft and regeneration

0-wall are dehiscences/fenestrations

combination - more walls apically > coronally

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83
Q

infrabony defects/pockets are contraindications for ___ surgery

A

MUCOGINGIVAL

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84
Q

osseous craters are __ % of all defects, and __ % of all mandibular defects?

more common in posterior/anterior?

A

1/3 (35%) of ALL defects
2/3 (62%) of all MANDIBULAR defects

more common in POSTERIOR

tx with osseous surgery

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85
Q

2 most critical factors to determine prognosis of periodontally involved tooth are

A

MOBILITY and ATTACHMENT LOSS

measuring attachment loss - probe from CEJ

ex. PD = 4 mm, recession = 3mm
- > loss = 7 mm

86
Q

__ is reshaping/recontouring alveolar bone that does not provide attachment for periodontal fibers without removing supporting alveolar bone

A

OSTEOPLASTY
-similar to gingivoplasty (they’re both not for eliminating pocket walls)

NON-supporting bone (bone not directly related to tooth support) removed ex. exostoses, edentulous ridges, tori

87
Q

bone grafting most successful with a __(#) wall defect

least successful with?

A

narrow, 3-walled
> 2, 1

through and through furcation on Mx molar

88
Q

most common side effect of autogenous bone grafts in infrabony pockets

A

root resorption

89
Q

some postop probs that happen after osseous or marrow transplants

A

infection
graft exfoliation
prolonged healing
rapid defect recurrence

90
Q

__ is a loss of buccal or lingual bone overlaying the root, leaving the root area only covered by soft tissue

A

dehiscence

91
Q

__graft is taken from a HUMAN and placed in another HUMAN

92
Q

__ __ is the bone donor graft with greatest osteogenic potential

A

hemopoietic marrow

93
Q

Guided Tissue Regeneration (GTR) is?

A

placing non-resorbable barries or resorbable membranes & barriers over a bony defect

blocks re-population of root surface by long jxn epithelium & gingival CT -> allow PDL and bone cells to repopulate the defect

94
Q

guided tissue regeneration assumes only __ cells have the potential to regenerate attachment apparatus

95
Q

GTR non-resorbable barriers include

A

expanded polytetrafluoroethylene ePTFE

96
Q

GTR resorbable membranes and barriers include

A

Type I bovine collagen, calcium sulfate, polyactic acid

97
Q

tissue regeneration is predictable in these 4 circumstances

A
  1. pt has good plaque control before and after
  2. no smoking
  3. there’s occlusal stability
  4. osseous defects are vertical with more walls
98
Q

surgical dressing materials should be.. (4)

A
  1. convenient
  2. flexible, while providing stability
  3. non-irritating
  4. smooth surface
99
Q

__ used to be the most popular agent in peiro dressings, but causes tissue injury and necrosis

today, dressings include (name 3)

A

EUGENOL

chemical cured - PerioCare, Coe-pak
visible-light cured - Baricaid

100
Q

do periodontal dressings help healing?

A

NO, it’s for comfort, tissue placement, and post-op bleeding

remove in 7-10 days

101
Q

__ in gingiva has a turnover rate significantly greater than in tendons and palate, but not as rapid as in ___. It accounts for __ % of gingival protein

A

Type I collagen

not as rapid as in the PDL

60% of gingival protein

102
Q

Vit C is required for hydroxylation of __ and __ which are essential for collagen formation

A

praline, lysine

103
Q

junctional epithelium is

A

collar-like band of stratified squamous epithelium, 10-20 cells thick near sulcus -> 2-3 cells thick at apical end

ranges from 0.25-1.35 mm long

NON-keratinizing epithelium

has 2 basal laminas

104
Q

__ cell layer is responsible for cell divisions, and contacts CT

A

proliferative cell layer

105
Q

JE desquamative (shedding) surface is at the

A

coronal end, forms bottom of gingival sulcus

106
Q

__ epithelium is more permeable than oral or sulcular epithelium

A

JXN

for passage of bacterial products from sulcus into CT, and for fluid and cells from CT into sulcus

107
Q

long junctional epithelium refers to

A

junctional epithelium in disease

migration occurs with CT degeneration, as JE proliferates along root (gets longer), the coronal portion detaches

barrier membranes can help stop long JE from forming

108
Q

epithelium attachment is the attachment apparatus that connects __ to __

A

JE to tooth surface via internal basal lamina and hemidesmosomes

109
Q

etiology of gingivitis

A

bacterial plaque

gingivitis is the PREDOMINANT perio disease, NO radiographic features

110
Q

3 stages of disease in developing gingivitis

A
  1. transient (incipient) stage - leukocytes by JE
  2. developing stage - fibrin, IgG, complement, B and T cells, macrophages
  3. chronic stage - plasma cells, IgA in saliva
111
Q

Ig_ is the most abundant in gingival exudates in gingivitis

A

IgG

lots of immunoglobulins are in epithelial and CT

112
Q

ANUG - acute necrotizing ulcerative gingivitis “Vincent’s infection” or “trench mouth” caused by these 2 bacteria

Signs and symptoms?

predisposing factors?

Tx?

A 
Fusiform spirochetes (Treponema denticola)
Prevotella intermedia

odor, fever, lymphadenopathy, neutrophils dominate

factors - hx gingivitis, smoking, bad OH, fatigue, stress, nutrition, immunocompromised

Tx - debride, hydrogen peroxide, penicillin V

113
Q

ANUG 2 most important clinical signs

A
  1. interproximal necrosis & pseudomembrane formation on marginal tissues, NO attachment loss
  2. Hx of soreness/pain and bleeding gums
114
Q

gram (+/-) bacteria in acute gingivitis?

A

Gram +

Actinomyces and Streptococci

115
Q

__ are most abundant cells in ACUTE inflammation

phases (2)

A

PMNs (neutrophilic leukocytes)
-first line of defense, migrates into gingival sulcus

  1. vascular - basophils, mast cells, platelets
  2. cellular - PMNs (leukocytes) via chemotaxis (C5a, leukotriene B4)

macrophages represent a transition btw acute and chronic inflammation

116
Q

local signs of acute inflammation usually accompanied by loss of fxn (5)

A 
rubor (redness)
calor (heat)
tumor (swelling)
dolor (pain)
systemic effects
117
Q

histamine is stored in what cells

A

mast cells, platelets, basophils

in VASCULAR phase of inflammation

anaphylactic response is characterized by degranulation of mast cells

118
Q

gram (+/-) cells in CHRONIC gingivitis?
aerobic/anaerobic?

what 2 species account for 75?

A

gram - ANAEROBIC

provetella intermedia
capnocytophaga

119
Q

in chronic gingivitis, there’s an increase in what cells?

A

plasma -> secreting IgG

B-lymphocytes

120
Q

__ are most numerous cells in inflammatory exudates of acute perio abscesses

A

neutrophils

121
Q

pellicle is a

type of bacteria?

A

glycoprotein deposit (plaque) from saliva

primary colonizers gram +
secondary are gram -
tertiary incl. spirochetes

122
Q

pattern in plaque formation is a shift of gram __ bacteria to gram __ bacteria

A

gram + facultative aerobes ->

gram - anaerobes

123
Q

most abundant bacteria in a health sulcus are __ and __ species

A

streptococcus (gram +)

actinomyces (filamentous)

124
Q

normal gram + (list 4)

normal gram - (list 5)

A

gram +
streptococcus, peptostreptococcus, actinomyces, lactobacillus

gram -
veillonella, fusobacterium, corynebacterium, campylobacter, eikenella

125
Q

pregnancy gingivitis

A

exaggerated response to plaque, loss in tissue tone, bright red, bleeding on pressure

1st or 2nd trimester can scale, polish, OHI
3rd - just OHI

during pregnancy, changes prob from PROGESTERONE and more MAST CELLS

126
Q

pregnancy gingivitis assoc. with incr. levels of __

A

prevotella intermedia

127
Q

most common gingivitis in school aged kids

A

localized acute gingivitis

128
Q

desquamative gingivitis, most pts are males/females?

characterized by?

A

females 40-70, postmenopausal

chronic, erythematous, erosive, vesiculobullous, and/or desquamative involvement of free and attached gingiva

from allergic rxn, assoc. with dermatologic conditions

tx by topical corticosteroids

129
Q

hereditary gingivofibromatosis

A

rare genetic disease, proliferation of gingiva

lack of inflammatory cells, proliferating capillaries, vascular engorgement

130
Q

inflammatory gingival enlargement

A

increase in sulcular depth and pocket formation

131
Q

drugs that induce OVERGROWTH (hyperplasia) of gingiva (3)

A 
phenytoin (dilantin) <-- highest
cyclosporine A (immunosuppressant)
nifedipine (procardia) (Ca channel blocker)
132
Q

how can you correct gingival contours for hereditary gingivofibromatosis and inflammatory gingival enlargement?

A

gingivectomy

133
Q

periodontitis is marked by

A

apical migration of JE from CEJ, loss of CT attachment and PDL, bone destruction

134
Q

more than __% of bone mass at the alveolar crest must be lost for a change in bone height to be recognized on radiographs

rdxn of __ to __ mm thickness of cortical plate is sufficient to permit xray visual of destruction of inner cancellous trabeculae

A

30%

0.5-1.0 mm
in health, crest lies 1-2 mm below CEJ

135
Q

radiographic changes in periodontitis (3)

A

loss of lamina dura
horizontal or vertical bone resorption
widening of PDL space

136
Q

loss of attachment is measured btw

attachment level is

A

CEJ and base of attachment

position of JE at base of pocket

137
Q

__ is the most reliable indicator of gingival or periodontal inflammation

138
Q

clinical probing is greater/lesser than the histologic sulcus or pocket depth

A

ALWAYS GREATER

139
Q

Naber’s 2N (Hamp Probe) is used to

A

detect and dx 4 types of furcations

140
Q

How can you treat Grade II furcations?

what teeth have the poorest prognosis after therapy?

A

guided tissue regeneration (GTR)

max 2nd molar

141
Q

most common etiology for gingival recession is

A

toothbrush abrasion

142
Q

toothbrush abrasion usually occurs on

A

canines and premolars

143
Q

dentin is abraded __x faster, and cementum __x faster than enamel

A

dentin 25x

cementum 35x

144
Q

hydronamic theory

A

cause of root sensitivity, dentinal fluid movement in the tubules stimulate mechanoreceptors

145
Q

dentinal hypersensitivity, main symptom?

how do you reduce it are removing a dressing?

A

COLD SENSITIVITY

keep roots free of plaque

146
Q

how to treat dentinal hypersensitivity? (6)

A
  1. topical fluoride - NOT acidulated phosphate fluoride
  2. fluoride mouth rinses
  3. desensitizing toothpastes
  4. iontophoresis - electroplating fluoride
  5. dentin bonding agents
  6. root coverage with gingival surgery (FGG)
147
Q

how do you calculate attached gingiva

A

subtract pocket depth from width of gingiva from free gingival margin to mucogingival margin

148
Q

plaque is made of a

extracellular matrix contains:

inorganic compounds? (2)

A

dextran matrix
80% water, 20% solids (20% is bacteria)
1010 bacteria/mg

ECM contains protein, polysaccharide, lipids

calcium, phosphorus

149
Q

bacterial constituents of plaque, early it’s gram __ and as plaque ages the number of gram __ decreases while number of gram __ increases

A

Early, gram + facultative bacteria ->
Later, gram - anaerobic
As it ages, gram + aerobic DECR.
and gram - anaerobic INCREASES

150
Q

Stages of plaque formation (3)

A
  1. Acquired pellicle formation
    - made of albumin, lysozyme, amylase, IgA, proline-rich proteins, mucins
    - bacteria free
  2. Bacterial colonization
  3. Maturation
    - bacterial intercellular adhesion -> calculus
151
Q

primary plaque colonizers are

secondary plaque colonizers are

tertiary plaque colonizers are

A

1: gram + facultative bacteria
Strep sanguis, Strep mutans, Actinomyces viscosus

2: gram - bacteria
Fusobacterium nucleatum, Prevotella intermedia, Capnocytophaga species

3: gram - anaerobic rods
Porphyromonas gingivalis, campylobacter rectus, Eikenella corrodens, Actinobacillus actinomycetemcomitans/AA, spirochetes (treponema)

152
Q

supragingival plaque is dominated by

subgingival plaque is dominated by

A

gram + facultative cocci

gram - anaerobic rods

153
Q

what is the most plaque retentive factor

154
Q

microbiologic etiologic factor in perio disease is __ but ___ is the most significant local contributing factor

A

dental plaque

calculus

155
Q

composition of calculus is

A

70-90 % inorganic
^at least 2/3 of that is CRYSTALLINE

10-15% organic - microorganisms, epithelial cells, leukocytes, mucin

156
Q

phases of calculus formation (3)

how many days does it take?

A
  1. pellicle
  2. plaque maturation
  3. ” mineralization, bathed plaque in calcium and phosphorus from saliva

12 days

157
Q

supragingival calculus, main source?

__ __ is the most common echanism that allows it to attach to smooth enamel

A

saliva

salivary pellicle

158
Q

subg calculus, source of minerals?

attachment is complicated by irregularities like:

A

crevicular fluid

darker from blood pigments, usually distributed evenly

irregularities: cemental tears, cemental voids (once occupied by Sharpey’s fibers), resorption bays, other cementum defects

159
Q

endotoxin is

A

LPS = lipopolysaccharide base

constituent of gram - microorganisms, can promote bone resorption, inhibit osteogenesis, chemotaxis of neutrophils

160
Q

enzymes that plaque bacteria produce (5)

A

collagenase - from bacteroides

hyaluronidase - from strep mitans and salivarius (breaks ground substance)

chondroitin sulfatase - by diptheroids (breaks ground substance)

elastase

proteases

161
Q

aggressive periodontitis (previously juvenile or early onset) has 2 forms:

A
  1. Generalized
    prevotella intermedia, eikenella corrodens
  2. Localized
    gram - anaerobes
    actinobacillus, capnocytophaga
    confined to INCISORS and 1st MOLARS
162
Q

AA & capnocytophaga are also assc. with perioodontitis in what condition

A

juvenile diabetes

163
Q

bacteria assoc. with periodontal health are gram __

what 2 species?

A

+, nonmotile, facultative anaerobes

strep and actinomyces species

164
Q

bacteria in perio disease are gram __

A

gram -, motile, strictly anaerobic

AA
P. gingivalis
Bacteroides forsythus
Treponema denticola, sokranskii
P. intermedia
Eikenella, Campylobacter, fusobacteirum, peptostreptococcus
Pseudomonas, eubacterium
165
Q

juvenile periodontitis principal bacteria (3)

A

capnocytophaga
prevotella intermedius
eikenella corrodens

Generalized - assoc. with systemic diseases
Localized - first molars, anterior teeth, absence of plaque!

166
Q

conditions that predispose a pt to developing inflammatory perio disease

A 
pregnancy
neutropenia
agranulocytosis
leukemias
diabetes mellitus
167
Q

perio disease might be an AUTOIMMUNE disorder, possible immune factors are:

A

interleukin-1 beta, interleukin-4, tumor necrosis factor alpha, prostaglandin E-2

168
Q

in excess, cytokines overproduce the enzyme

A

collagenase! also causes inflammation, severe damage

169
Q

people with hyper-inflammatory monocyte/macrophage phenotype secrete more

A 
pro-inflammatory mediators like
IL-1 beta
IL4
TNF-alpha
PGE2
170
Q

perio disease can be assoc. with these systemic diseases

A

Down’s
HIV/AIDS
hormone imalances
uncontrolled type I and II diabetes

171
Q

people with type I and II diabetes have __x the risk of getting perio disease

172
Q

the single major preventable risk factor for perio disease

A

smoking

  • reduce oxygen, trigger cytokines
  • cigars and pipes are equal risk
173
Q

autoimmune conditions assoc. with perio disease

A

Crohn’s
rheumatoid arthritis
lupus erythematosus
CREST syndrome

174
Q

purpose of SRP is to remove (3)

A

calculus, bacteria, endotoxins

175
Q

there’s potential for abscess formation in a deep pocket only when

A

a superficial scaling is performed

176
Q

sharpening, degrees?

__ is used with natural stone
__ used with synthetic

A

100-110

oil + natural
water + artificial

177
Q

in RP, working stroke begins at __ edge of JE (base of the pocket)

178
Q

difficult to do SRP on these surfaces (3)

A

mesial of max premolars
proximal of md incisors
trifurcations of max molars

179
Q

if after SRP pt returns in a week with hard, black deposits around gingival margin, it means

A

rdxn in inflammation, and now old calculus is exposed

180
Q

best criterion to evaluate success of SRP is

A

no bleeding on probing

181
Q

periodontal hoes and files are used exclusively for

A

heavy accessible SUPRAgingival calculus

hoes - single straight cutting edge, good for buccal and lingual surfaces

files - fxn to crush or fracture calculus, good for B/L, next to edentulous areas, reduce amalgam overhangs

182
Q

order of strokes in root planing

A

vertical ->
oblique ->
horizontal

183
Q

objective of gingival curettage

re-epitheliazation occurs within __ days

A

remove chronically inflamed, diseased epithelial lining and microorganisms from pocket to reduce edema and pocket depth

often with RP to promote soft tissue attachment

7-10 days

184
Q

most important factor to determine amt of shrinkage is

A

degree of edema in tissue

healing starts with blood clot formation

185
Q

instrument that’s least traumatic and most effective for non-surgical RP

A

periodontal curette

for subg calculus

186
Q

chisel designed to remove

A

SUPRAgingival calculus in IP areas

187
Q

main fxn of cementum is

2 types of collagen are

A

attachment of PDL principal fibers

Sharpey’s fibers - terminal parts of PDL, run PERPENDICULAR to cementum

Type I collagen fibers - PARALLEL to cementum

188
Q

radicular cementum increases/decreases with age?

thickness?

2 types

A

INCREASES

0.05-0.6 mm

cellular - apical third, has cementocytes in lacunae
acellular - FIRST cementum to be formed, coronal 2/3, thinnest at CEJ and is part of tooth anchorage

189
Q

primary occlusal trauma

early effects?

secondary occlusal trauma

A

normal supporting structures, no perio disease, reversible

early effects are hemorrhage and thrombosis of PDL blood vessels

secondary when periodontium compromised

190
Q

teeth tend to loosen in what direction?

191
Q

most common symptom with PERIODONTAL ABSCESS is

tx if localized?

A

acute pain - constant, severe, dull throbbing

thermal changes don’t elicit or modify the discomfort

localized -> drain, but if not then antibiotics

192
Q

PERIO-ENDO ABSCESS tx?

Signs and symptoms?

A

RCT -> 2-3 months -> antibiotics, SRP, perio surgery if needed

radiographic involvement of periodontium and periapex, significant probing depths, percussion and pulpal sensitivity

193
Q

PERIODONTAL CYST can present as a

A

localized tender swelling

  • usually asymptomatic
  • see on xray interproximal perio cyst on side of the root (can’t differentiate from perio abscess)
194
Q

APICAL PERIODONTAL CYST has a predilection for what area?

teeth are vital/non-vital? symptomatic/asymptomatic?

A

mandibular canine-premolar

vital, asymptomatic
-no perio pockets

-surgical removal of cyst

195
Q

toothpaste ingredients (6)

A
  1. Polishing
  2. Binder (thickener)
  3. Surfactant - sodium lauryl sulfate
  4. Humectant - retains moisture
  5. Flavoring
  6. Active ingredient
196
Q

Polishing (abrasive agent) in toothpaste can be (3)

what does it do?

contraindications of using abrasives and/or rotary polishing instruments are:

A

silica, calcium carbonate, alumina

removes stain, stained pellicle, plaque

contraindicaitons: pts with communicable disease/respiratory probs, “green stain,” newly erupted teeth, pts at risk for caries

197
Q

active ingredients in toothpaste include

A 
fluoride
triclosan - antiplaque
pryophosphate - anticalculus
potassium nitrate - desensitizing
peroxides
198
Q

3 toothbrushing methods

A
  1. Bass (Sulcular) - 45 deg to tooth surface at gingival margin, PREFERRED METHOD
  2. Modified Stillman (Roll) - bristles on cervical of tooth pointing to gingival margin, brush moves coronally
  3. Charter’s - point away from gingiva at 45 deg
199
Q

what color stains on anterior teeth are caused by poor OH?

A

orange
green
brown

200
Q

Other homecare perio aids (5)

A
  1. Perio-Aid - like toothpick, clean at gingival margins
  2. Stim-U-Dent for interndental recession
  3. Interproximal brushes (proxabrush)
  4. Interdental stimulator - rubber tip, stimulates circulation of interdental gingiva
  5. Water irrigating devices - remove food debris, non-adherent bacteria, CONTRAINDICATED in pts with periodontal inflammation, pts on antibiotics (can cause bacteremia)
201
Q

fluoride, ___, and __ can inhibit microbial plaque

A

fluoride
antibiotics
chlorhexidine

202
Q

chlorhexidine gluconate

A

has alcohol, best antimicrobial for reducing plaque and gingivitis over long-term, absorbed onto teeth and pellicle and slowly released, stains oral tissues yellow-brown

203
Q

what essential oils are the active ingredients in phenol based mouthrinses?

contain what % alcohol?

A

thymol
menthol
eucalyptol
methyl salicylate

20-27% alcohol

204
Q

stannous fluoride antimicrobial action related to what ion?

it is anti-___

A

TIN

antiCARIES only

205
Q

quaternary ammonium compounds are good for

A

getting rid of bad breath

-contains cetylpyridinium

206
Q

what is ATRIDOX?

A

doxycycline hyclate 10%

locally applied antibiotic, placed below gum line into pockets, bioabsorbable, releases abx for 21 days

207
Q

what is ARESTIN?

A

minocycline hydrochloride

powder form, inside pockets after SRP, microspheres release abx 21 days

208
Q

what is ACTISITE?

A

tetracycline hydrochloride

  • periodontal fiber as adjunct to perio therapy to reduce pockets and bop
  • NON-bioabsorbable -> remove ater 10 days
209
Q

what is PERIOCHIP?

A

chlorhexidine gluconate

-into pockets as adjunct to SRP, bioabsorbable

210
Q

Extrinsic dental stains

  1. brown is due to __
  2. tobacco
  3. black caused by
  4. green or green-yellow common in what age group? due to what bacteria?
  5. metallic
A
  1. brown - pellicle, TANNIN
  2. tobacco - coal tar
  3. black - CHROMOGENIC bacteria (actinomyces)
  4. green - kids, FLUORESCENT bacteria
  5. metallic - metal dust, drugs with metals

NBDE II Board Busters (11 decks)

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